Bill Text: TX HB3041 | 2019-2020 | 86th Legislature | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the renewal of a preauthorization for a medical or health care service.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-07 - Effective on 9/1/19 [HB3041 Detail]
Download: Texas-2019-HB3041-Engrossed.html
Bill Title: Relating to the renewal of a preauthorization for a medical or health care service.
Spectrum: Bipartisan Bill
Status: (Passed) 2019-06-07 - Effective on 9/1/19 [HB3041 Detail]
Download: Texas-2019-HB3041-Engrossed.html
By: Turner of Tarrant, Kacal | H.B. No. 3041 |
|
||
|
||
relating to the renewal of a preauthorization for a medical or | ||
health care service. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended | ||
by adding Chapter 1222 to read as follows: | ||
CHAPTER 1222. PREAUTHORIZATION FOR MEDICAL OR HEALTH CARE SERVICE | ||
Sec. 1222.0001. DEFINITIONS. In this chapter: | ||
(1) "Health benefit plan" means a plan to which this | ||
chapter applies under Section 1222.0002. | ||
(2) "Health benefit plan issuer" means an entity | ||
authorized under this code or another insurance law of this state | ||
that provides health insurance or health benefits in this state. | ||
(3) "Preauthorization" has the meaning assigned by | ||
Section 1301.001. | ||
Sec. 1222.0002. APPLICABILITY OF CHAPTER. (a) This | ||
chapter applies only to a health benefit plan that provides | ||
benefits for medical or surgical expenses incurred as a result of a | ||
health condition, accident, or sickness, including an individual, | ||
group, blanket, or franchise insurance policy or insurance | ||
agreement, a group hospital service contract, or an individual or | ||
group evidence of coverage or similar coverage document that is | ||
issued by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a health maintenance organization operating under | ||
Chapter 843; | ||
(4) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844; | ||
(5) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; | ||
(6) a stipulated premium company operating under | ||
Chapter 884; | ||
(7) a fraternal benefit society operating under | ||
Chapter 885; | ||
(8) a Lloyd's plan operating under Chapter 941; or | ||
(9) an exchange operating under Chapter 942. | ||
(b) Notwithstanding any other law, this chapter applies to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507; | ||
(3) a basic coverage plan under Chapter 1551; | ||
(4) a basic plan under Chapter 1575; | ||
(5) a primary care coverage plan under Chapter 1579; | ||
(6) a plan providing basic coverage under Chapter | ||
1601; | ||
(7) health benefits provided by or through a church | ||
benefits board under Subchapter I, Chapter 22, Business | ||
Organizations Code; | ||
(8) group health coverage made available by a school | ||
district in accordance with Section 22.004, Education Code; | ||
(9) the state Medicaid program, including the Medicaid | ||
managed care program operated under Chapter 533, Government Code; | ||
(10) the child health plan program under Chapter 62, | ||
Health and Safety Code; | ||
(11) a regional or local health care program operated | ||
under Section 75.104, Health and Safety Code; and | ||
(12) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code. | ||
Sec. 1222.0003. PREAUTHORIZATION RENEWAL REQUEST. A health | ||
benefit plan issuer that requires preauthorization as a condition | ||
of payment for a medical or health care service shall provide a | ||
preauthorization renewal process that allows a renewal of an | ||
existing preauthorization to be requested by a physician or health | ||
care provider | ||
at least 60 days before the date the preauthorization | ||
expires. | ||
Sec. 1222.0004. DETERMINATION REQUIRED. If a health | ||
benefit plan issuer receives a preauthorization renewal request | ||
before the existing preauthorization expires, the health benefit | ||
plan issuer shall, if practicable, review the request and issue a | ||
determination indicating whether the medical or health care service | ||
is preauthorized before the existing preauthorization expires. | ||
SECTION 2. The change in law made by this Act applies only | ||
to a health benefit plan that is delivered, issued for delivery, or | ||
renewed on or after January 1, 2020. A health benefit plan that is | ||
delivered, issued for delivery, or renewed before January 1, 2020, | ||
is governed by the law as it existed immediately before the | ||
effective date of this Act, and that law is continued in effect for | ||
that purpose. | ||
SECTION 3. This Act takes effect September 1, 2019. |